project axxes/usaid
DESCRIPTION
Project AXxes/USAID. Project Overview March 24 th , 2009. Three Components of Project AXxes for HZ Development: A: Increase access to… integrated PHC B: Increase capacity of Health Zones & referral system C: Reinforce national programs & provincial/district offices. - PowerPoint PPT PresentationTRANSCRIPT
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Project AXxes/USAIDProject Overview March 24th, 2009
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Three Components of Project AXxes for HZ Development:A: Increase access to… integrated PHCB: Increase capacity of Health Zones & referral system C: Reinforce national programs & provincial/district offices
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Component A : Increased access to integrated care.
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1. Reinforcement of Rural HC Facilities
Photo Clemmer /Kisangani/07
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1a. Rehabilitated 218 HC facilities!Before After
Photo: CRS/Apr 08
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1b. Equipped them with:• Solar Lights• Diagnostic Kits• Registers/Charts/• Equipment• Medicine
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1c. Supplied them with:• Pharmaceuticals• Gloves• Gauze• Waste Disposal• Syringes• Means of Transport
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2. Training of personnel• Over 23,000 trained to
date• PMA, Reproductive
Health, • Rational Prescription• Newborn Care. Family
Planning• C-IMCI, etc.• Etc.
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3. Established Pharmaceutical Supply Line• Established 5 regional
project depots• Purchased over 5M worth of
W.H.O. essential medicine• Implementation of drug
credit system to encourage recycling
• Training in stock management/recycling/ordering
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4. Support of clinical services
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4a. Vaccination Services▫ Re-established cold chain▫ Supply of solar and
kerosene units ▫ Supply of vaccination
related material (i.e. syringes)
▫ Support of campaigns and routine CPS clinics
▫ Monitoring▫ Surveillance
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Immunizations
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4b. Family Planning Services
• Established 864 sites• Training of family
planning prestataires• Provision of family
planning clinical kits• Order and delivery of
products (OC, IUD, Depo, Cycle Beads, etc)
YEAR 1 YEAR 2
Q1Q2Q3Q4Q5Q6Q7Q8
0K
5K
10K
15K
Sum of ACP
10,000 10,000
Couple Year Protection evolution up to present
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4c. Reproductive Health Services(safe delivery, AMSTL, and newborn resuscitation)
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4.d Antenatal Services
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4e. Community IMCI• Trained staff in 929 clinics in
basic Clinical-IMCI • Trained over 4700 relais to
date in community based-IMCI
• Establishment of up to 200 community care sites (ongoing)
• Printing of flipcharts/ IEC material
• Dissemination of health messages (ten commandments of health) to households
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Key Behavior Messages for’ Care Seeking’ and for ‘Malaria Treatment and Prevention’
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4f. Micro-nutrient support• Vitamin A campaign and
routine use of Vitamin A with support from UNICEF and HKI
• Introduction of Zinc nationwide as Rx protocol (USAID first to introduce in provinces)
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5.Water and Hygiene • Constructed/Capped over 280
water springs• Trained water/sanitation
engineers in all supported HZs• 212 clean village projects• 3500 latrines fabricated
(UNICEF)
before
after
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6. Disease Specific Intervention
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6a. Malaria• 1. Purchase and delivery of
540,000 ITNs• Introduction of ACTs* to all
clinics as primary treatment of Malaria
• ITP treatment instituted in all ANC clinics
*Imported 1,165,875 doses of ACT
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6b. HIV• Blood Safety: Introduced
and support screening for HIV, RPR, Hepatitis B in all 57 zones.
• Establishment of 129 PMTCT sites with 63 pilot programs in triple therapy ARV with support from Axios and Abbott
• Treatment of STI/co-infection TB/ARV therapy with Global Fund
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6c. Tuberculosis• Support of TB Detection
and Treatment Programs• Supply of government
provided medicine to sixteen isolated health regions
• Training, supervision, surveillance in high risk areas
• Production of PATI-4 module
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6d. GBV Related Issues• Community wide
campaigns on prevalence and awareness
• Focused intervention to at risk groups
• IEC awareness• Fistula repair and
prevention
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Component B Increase capacity of Health Zones & referral system
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1. Reinforce and Support Formative Supervision of all Health Centers
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2. Training of ‘Equipe Cadre’• Health zone management
(commodities and finance)• Disease Surveillance• Monitoring and Evaluation• Adherence to ordinogramme
(clinical guidelines)• Zone specific training
▫ Management▫ PMA▫ Surveillance
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3. Surveillance and Monitor Vital Health Statistics • 1. Calendar and
Charting of indicators• 2. SNIS• 3. Dashboard
(Tableau)• 4. Monthly reporting
and verification • 5. Support monthly
health zone reunion with staff from all HCs
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4. Transparence and Governance
• 1. CODESA health center board
• 2. Annual HZ meetings
• 3. Co-gestion of health facilities
• Community planning of programs and campaigns
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5. Promising Partners Grants• Support of local NGO-
initiated income generating projects to sustain health projects
▫ CODESA (GBV)▫ AFIA (nutritional)▫ HALT-SIDA (BCC)▫ VAS (nutritional)
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Livelihood agricultural project linking health center (Project) AXxes with DEVRU
Photo: Niles/Mutoto CS/2008
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Component C: Reinforce national programs & provincial/district offices
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1. Supervision and functioning of District Medical Offices
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District Medical Office of Kamina
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2. Policy Review and Revisions• 1. PMTCT• 2. SNIS• 3. Reproductive
Health• 4. Family Planning• 5. Malaria
treatment• 6. Essential Drug
List• 7. Training
protocols
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3. Annual Reviews, Strategy Planning, Conferences and Work Plans (PNLP, PNLS, PNSR)
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4. Data Storage and Management at Level of Ministry of Health
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IV SHORTFALLS
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Need to promote care-seeking behavior
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Breaking the 35% barrier
Q2Q3Q4Q5Q6Q7Q8
20%
25%
30%
35%
Use of ServiceS
35%
Rate of Use of Health trend YEAR 1 YEAR 2
Q2Q3Q4Q5Q6Q7Q8
0K
200K
400K
600K
Use of services
637,536 637,536
Use of Health services' trend
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Dr Lauren Blum (Care Seeking Behavior Study)
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Decrease distance and barriers to care
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Establishment of 200 Community Care Sites for Clinical-IMCI
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Sustainability of what was built
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Understand Partnership• 1. Primes• 2. Incentives• 3. Performance Contracts• 4. Integrity• 5. Unmet expectations• 6. “you didn’t give us..
oil for the oil change dispenser bags for
prescription meds Sand for the concrete
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V Challenges
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1. Povertyas an impediment to access to care
Photo: Lodja.June 2008/Mulongo
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2. Infrastructure (or lack of) as an impediment of access for project personnel
Photo: ECC/AXxes 2008
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Road Transport in DR Congo
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Photo: National Highway #1 BDD/Mar 07/Clemmer
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Photo: Equateur Province.Mar 08/ Mulongo
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3. Delivery of Project Commodities
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N° DESCRIPTION
Suppliers MODEDestination1 Frigo Sibir Kinshasa WEM Sea freight2 Tables Opération & Lampes scyalitiques Kinshasa WEM Sea freight
3 Cars(10 + 01) Kinshasa WEM Sea freight
4 GIK 1:Ordinateurs, solar batteries Kinshasa IMA Sea freight
5 GIK 2:Solar systems Kinshasa IMA Sea freight
6 Table gyneco,Vaccine carriere(Unicef) Kinshasa UNICEF Sea freight
7 Table examen(Unicef) Kinshasa UNICEF Sea freight
8 Mini Kits/Gloves/Chirurgical sets Kinshasa IDA Sea freight
9 Medecines for dépôts (+/-50% of order amount )Knga,Klzi,Kma&Kowzi Kinshasa IDA Sea freight
10 Medecines for Dépôt BUKAVU(+/- 35% of order amount) Bukavu IDA Sea freight
11 Nets (30000 pour ECC) Kinshasa VESTEGAARD Sea freight
12 Nets (120000 pr Bukavu) Bukavu VESTEGAARD Sea freight
13 Nets (30000 L'shi ) Lubumbashi VESTEGAARD Sea freight
14 Solar Refrigerator Kinshasa SUNDANZER Sea freight15 GIK3: baptists commodities KINSHASA IMA Sea freight
16 GIK4:labo kits,microscopes,furnitures; computers;Tasok… KINSHASA IMA Sea freight17 Medecines for BUKAVU(Year1 part2) BUKAVU IDA Sea freight
18 Medecines to Kinshasa for ECC&WVI Ktga(Year1 part2) KINSHASA IDA Sea freight
19 Nets(to Kinshasa for ECC Kasai & Ktga) KINSHASA VESTEGAARD Sea freight
20 Nets(to BUKAVU for CRS & WVI) BUKAVU VESTEGAARD Sea freight
21 Nets(to Lubumbashi for WVI & ECC Ktga) LUBUMBASHI VESTEGAARD Sea freight
22 GIK5: divers IMA/PCUSA/TASOK… KINSHASA IMA Sea freight
23 Autoclave/Sterilizer ASCO KINSHASA ASCO Sea freight24 Tables examination,obstetrical KINSHASA ASCO sea freight25 Freezers(72) KINSHASA Electrolux Sea freight26 SP/Oxytocine/Vitamine A/New born Kit… KINSHASA IDA Airfreight
27 Medicines Y2(po 40063&po40137) IDA Bukavu BUKAVU IDA Sea freight/road
28 Medicines Y2(and Y1P2) IDA Kinshasa KINSHASA IDA Sea freight
29 Medecines Y2(cpd,gloves,medecines,,,0 40068;40073;40134/133;40139/168) KINSHASA IDA Sea freight30 GIK 6 KINSHASA IMA
31 Cycles beads KINSHASA Cycles technologies Sea freight32 Seringues AB KINSHASA BD Sea freight33 Simulators/New born KINSHASA IMA
34 Medicines Y2/MP LUBUMBASHI Mission Pharma Sea freight35 Medicines Y2/MP KINSHASA Mission Pharma Sea freight36 Medicines Y2/MP BUKAVU Mission Pharma Sea freight37 Medecines Y2/MP(narcotics) KINSHASA Mission Pharma Airfreight38 CPD-a-bag for blood taking KINSHASA IDA Sea freight39 Nets year 3/Bukavu,62500pcs BUKAVU VESTEGAARD Sea freight
40 Nets year 3/Lubumbashi,60000pcs LUBUMBASHI VESTEGAARD Sea freight41 Nets year 3/Kinshasa, 30000pcs KINSHASA VESTEGAARD Sea freight
42 Cycles beads Year 3 KINSHASA Cycles technologies Sea freight43 Nets year3/Bukavu,27500pcs BUKAVU VESTEGAARD sea freight44 GIK 7:solar system/batteries, vehicle… KINSHASA IMA sea freight
45 Medicines Year 3/IDA Lubumbashi LUBUMBASHI IDA sea freight
46 Medicines Year 3/IDA, Cotri pmtct, blood giving set Kinshasa KINSHASA IDA sea freight
47 Medicines Year 3/IDA, Bukavu BUKAVU IDA 48 Gauze/Glove/Fistula kit KINSHASA IDA sea freight
49 Medicines/cotri pmtct LUBUMBASHI IDA seafreight50 Medicines/cotri pmtct KINSHASA IDA seafreight51 medicines ACTs/IDA Year 3 KINSHASA IDA seafreight
Container Manifest (container #71 is at Matadi!)
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Import Route of International Shipping Containers Project AXxes (2007-2009)
Port of Matadi (44)
Tanzania(16)
Zambia (11)
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4. Limited means of commercial transport to health zones (safe) once it gets into DRC
Photo Goma Apr 08/cnn.com
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Dr Ebonabo/AXxes/Malemba-Nkulu 07
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Photo: Route de Matadi Apr.08/Clemmer
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Carlson/Karawa Health Zone/Mar 09
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Carlson/Karawa Health Zone/Mar 09
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5. Weak Government Support to Health Zones
Photo: General Hospital, South Kivu 2004/Clemmer
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8. Underestimating the size (and weight) of the challenge
Photo Clemmer/Kinshasa/2006
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7. Retention of trained personnel
Photo: ITM Sona Bata. 2004/Clemmer
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8. Chronic Insecurity
Photo Mission Hospital Occupied by armed elements:. South Kivu. Apr 02/Cemmer
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Continued conflict in the Kivus
Photos: CNN.Com /DRC/2005.
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9. Resurging Epidemics
Photo: Ebola.Outbreak.Ground Zero. Mweka.Oct 07/Clemmer
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Photo/Clemmer/Bulape/08
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10. Global Economy and Outlook
?
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Mission Aviation Fellowship (USA)
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USAID Assessment of SANRU III (2004)